Hooked on the Net?

The topic of internet addiction is one which is sure to crop up, in some sensationalised form, every few months in the science section of newspapers. So it was not surprising to read this piece a few days ago in The Independent, reporting the results of a study by Lin and colleagues. The study found that the integrity of white matter (the brain tissue through which signals are transmitted) was reduced in the 17 subjects diagnosed with “Internet Addiction Disorder”. These apparently “groundbreaking” results show just how serious internet addiction can be. Putting aside any issues with interpretation of the original study itself (we all know that correlation does not equal causation!), what is common to all of these kinds of articles is the unquestioning – and perhaps mistaken – acceptance of Internet Addiction Disorder as a real mental illness.

The Diagnostic and Statistical Manual of Mental Disorders (DSM), the mental health professional’s Bible, does not currently recognise addiction per se as a mental disorder. Thus, early researchers compared symptoms of substance dependence (or drug addiction, which is in the DSM) with those of excessive internet users. They found that internet addicts often appeared to fit the criteria, which included “heavier use than intended” and “large time devoted to use”. Particularly influential was Dr Kimberley Young. She attempted to create a formal definition of internet addiction by adapting the DSM criteria for another disorder called pathological gambling. This led to the development of the Internet Addiction Test, a version of which was used in the study reported by The Independent, and which is available online here at Young’s website.

Studies using tests such have found that 5-10% of respondents fit the criteria for “addiction”, and some have called for Internet Addiction Disorder to be recognised in the next version of the DSM. However, defining internet addiction based on criteria for substance dependence or pathological gambling seems fundamentally flawed. While gambling or taking drugs are essentially unconstructive behaviours, internet use incorporates a variety of activities, many of which are productive. Indeed, internet use may often allow us to perform “normal” tasks through a different medium. If this is the case, should we even be concerned if our use appears excessive? Have a look at Young’s internet addiction test, but imagine that “on-line” and “Internet” were substituted with “hanging out with friends”. I’m sure that many of us often “hang out with friends longer than intended” or “fear that life without friends would be boring”, but we would find it ridiculous if someone suggested that we had “Friend Addiction Disorder”. Yet, socialising is one of the major activities associated with internet. Similar logic can be applied to other internet-enabled activities such as reading, watching TV shows or educating ourselves.

The idea of people suffering from some general internet addiction thus seems too simplistic. Indeed, what appears to be internet addiction may often be addiction to a certain aspect of the internet, which could still manifest itself in the absence of the web. For example, someone who is addicted to internet gambling probably suffers from pathological gambling rather than addiction to the internet. Apparent compulsive use of the internet may also be symptomatic of some other underlying disorder. In a 2000 paper, Shapira and colleagues found that 20 subjects displaying “problematic internet use” all fit the criteria for other disorders as well, the most common being mood and anxiety disorders. Other studies have found similar results. To illustrate this point, consider someone with social anxiety, who may use the internet a lot because they are scared to go out. If the internet did not exist, then they may equally have stayed home watching TV excessively.

Ironically, the term “Internet Addiction Disorder” was first coined by Dr Ivan Goldberg as a joke. It served as a protest against the tendency toward seeing behaviours as medical conditions. It seems fitting to give him the last word:

“To medicalize every behavior by putting it into psychiatric nomenclature is ridiculous. If you expand the concept of addiction to include everything people can overdo, then you must talk about people being addicted to books, addicted to jogging, addicted to other people.”